General Discussion
In reply to the discussion: If you unfairly, wrongly and very publicly attack someone, shouldn't you apologize? [View all]pnwmom
(110,251 posts)that non-exchange insurers don't accept people with preexisting conditions, I understood he was in a vulnerable position because of his wife's terrible illness. So I didn't chew him out about that.
I just told him that his friend the agent was giving him false information. And suggested he look into all the formularies, both in and outside the exchange (since he had already mentioned looking outside the exchange, and reported that his friend said that would be a waste of time -- not that he couldn't afford it.) And I told him how there was an inside appeal and an outside appeal, and a process for having a doctor request an exception to the formulary.
Under the ACA, no insurance company, on or off the exchange, can exclude all of a class of drugs. This is an improvement on the law that existed until now. It's also an improvement that there is a fast way to appeal, both inside and outside the insurer, and to have your doctor request an exception for your medication if necessary.
We still have a long way to go. Yes, we do. And one thing we have to look at is price-gouging by the drug companies. They are not charging based on development costs. Their whole price philosophy, in a nutshell is this: WHAT THE MARKET WILL BEAR. So they charge simply based on what similar products are charging, and what they can get insurers to pay for. Does that really make sense to you?